| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,798 |
8,675 |
$1.32M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
164 |
164 |
$169K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
867 |
246 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
791 |
479 |
$99K |
| D0350 |
|
972 |
393 |
$89K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
154 |
153 |
$78K |
| D8660 |
|
3,069 |
3,055 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
817 |
398 |
$73K |
| D0470 |
|
1,236 |
1,093 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,250 |
1,252 |
$53K |
| D9310 |
|
936 |
935 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,035 |
935 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
361 |
136 |
$39K |
| D9222 |
|
154 |
153 |
$25K |
| D0340 |
|
619 |
614 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,256 |
1,230 |
$23K |
| D9610 |
|
236 |
137 |
$18K |
| D1120 |
Prophylaxis - child |
329 |
328 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
270 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
98 |
$11K |
| D8680 |
|
25 |
13 |
$9K |
| D0330 |
Panoramic radiographic image |
1,195 |
1,054 |
$8K |
| D1999 |
|
930 |
915 |
$8K |
| D1206 |
Topical application of fluoride varnish |
248 |
248 |
$5K |
| D1510 |
|
17 |
12 |
$4K |
| D2332 |
|
29 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
155 |
153 |
$2K |
| D1354 |
|
81 |
27 |
$2K |
| D1352 |
|
37 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
35 |
25 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$720.00 |
| D1310 |
|
15 |
15 |
$690.90 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$560.00 |
| D0603 |
|
15 |
15 |
$225.30 |